Different Combinations of Glucose Tolerance and Blood Pressure Status and Incident Diabetes, Hypertension, and Chronic Kidney Disease

Abstract

Background The impact of different combinations of glucose tolerance and blood pressure status on the development of type 2 diabetes mellitus (T2 DM ), hypertension ( HTN ), and chronic kidney disease ( CKD ) still needs to be investigated. Methods and Results A total of 12 808 Iranian adults aged ≥20 years were included in 3 separate analyses to investigate incidence of T2 DM , HTN , and CKD . Multivariate Cox proportional hazard models were used to calculate hazard ratios (95% CI ). During a median follow‐up of >10 years, the overall incidence rate for T2 DM , HTN , and CKD was 12.2, 29.8, and 24.8 per 1000 person‐years. For incident T2 DM , considering normal glucose tolerance/normal blood pressure as reference, prediabetes (Pre DM )/ HTN had the highest risk (hazard ratio: 7.22 [5.71–9.12]) while Pre DM /normal blood pressure also showed a significant risk (5.58 [4.41–7.05]). Furthermore, risk of Pre DM / HTN was higher than Pre DM /normal blood pressure ( P <0.05). For incident HTN , normal glucose tolerance/prehypertension was a strong predictor (3.28 [2.91–3.69]); however, addition of Pre DM or T2 DM did not increase the risk. For incident CKD , every category that included HTN and/or T2 DM showed significant risk; this risk was marginally significant for the Pre DM / HTN group (1.19 [0.98–1.43], P =0.06). In addition, Pre DM / normal blood pressure was a marginally significant risk factor for incident HTN while normal glucose tolerance/prehypertension was a significant predictor of T2 DM . Conclusions Presence of HTN was associated with increased risk of T2 DM among the Pre DM population; however, dysglycemia did not increase the risk of HTN among individuals with prehypertension. For incident CKD , intensive management of HTN and T2 DM , rather than their predisease states, should be considered.